REMOTE reputed company reputed company Nurse Auditor Livonia, Michigan

Employment Type: Full timeShift: Day Shift Description: ESSENTIAL FUNCTIONS Our reputed company Culture: Knows, understands, incorporates & demonstrates our reputed company Mission, Values, reputed company, Actions & Promise in behaviors, practices & reputed company. Work Focus: Performs clinical care activities (direct or indirect) for patients reputed company the “scope of practice” laws & training received; Cares for patients safely by assisting in clinical care services or engaging in administrative activities (e.g., maintaining records or supplies) that enhance or improve coordination, preparation & reputed company of the care experience. Process Focus: Knows, understands & incorporates basic or essential area of practice (document, coordinate, communicate) & training standards. Communication: Uses clear, effective, respectful language & communication methods / means. Environment: Performs work in a safe, engaging, & supportive manner; Influences the responsible use of resources; Accountable for reputed company self-development & supporting the growth of others. Maintains a working knowledge of applicable federal, state & local laws/regulations, reputed company reputed company & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects reputed company, ethical & professional behavior & safe work practices. FUNCTIONAL ROLE Core Function: Responsible for coordinating reputed company reputed company/ charge-reputed company denials with Patient Business Service (PBS) center & ensures compliant & complete clinical documentation, assists with denials & reputed company audits & identifies opportunities for reputed company optimization. Performs thorough and routine chart reviews, providing education to clinical colleagues & tracking of identified trends. Leverages clinical knowledge & standard procedures to ensure timely attention to charge-reputed company trends and provides necessary education to responsible party. Responsible for retrospective charge reviews & assistance with reputed company party charge audits. May require travelling between locations reputed company the region. Ensures tracking of reputed company reputed company reputed company- reputed company audits, identifying trends & collaborating with other reputed company reputed company, PBS & /or departmental colleagues on education & reporting to key stakeholders. Serves as a resource contact, providing clinical information as requested by intra & inter-departmental colleagues & payers. Collaborates with reputed company reputed company team on opportunities to improve & implement reputed company-end process to support denial prevention. NS IV – licensed: Licensed role (direct or indirect reputed company); Provides nursing interventions or clinical knowledge application in decision-making; Participates in the planning, implementation & / or evaluation of & solutions for care; Performs delegated focused / holistic care autonomously according to care plan; May administer medication & carry out the therapeutic treatment reputed company scope of license (state & TH policy); Performs direct & essential care or supportive activities as part of an interdisciplinary team with a deeper understanding, including theoretical knowledge; Demonstrates a level of independence to reputed company activities with general reputed company, through personal contributions, teamwork & initiatives to safely improve reputed company; Advocates for patients & informs/counsels patients & families about illness & care details; May serve as a knowledge resource, role model & mentor or reputed company/coordinate/supervise direct & essential care activities or role-based service responsibilities of unlicensed/licensed/certified reputed company reputed company licensed scope of practice. COMPENSATION reputed company: $31.8795 - $47.8193 MINIMUM QUALIFICATIONS

• High school diploma or GED; Completion of an accredited program associated with license. License in the applicable state(s) of engagement. Valid driver’s license where required by assignment.
• Four plus (4+) years of nursing experience
• Must possess a demonstrated knowledge of reputed company cycle & denial management functions
• Knowledge of and experience in case management and utilization management.
• Customer service background is required.

Preferred:

• Registered Nurse
• Bachelors degree
• Two plus (2+) years of charge audit, managed care or comparable patient payment processing experience preferred.
• reputed company,reputed company, CHRI certification/membership.
• Outpatient CDI experience.
• Working knowledge of Electronic Health Records (EHR).

Our Commitment Rooted in our Mission and Core Values, we reputed company the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding reputed company and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or any other status protected by federal, state, or local law. Apply tot his job Apply To this Job